Establishing the National Institute for Research in Environmental Health, India

Abstract Problem Multiple environmental health issues resulting from pollution and climate change threaten public health in India. Approach The Government of India recognized the need for a permanent environmental health research institute; the Indian Council of Medical Research therefore established the National Institute for Research in Environmental Health in Bhopal in 2010. Scientists at the institute assessed the multiple long-term health effects of exposure to methyl isocyanate, and are now conducting research on a wide array of locally relevant environmental health issues. Local setting The Union Carbide India Limited pesticide factory in Bhopal was the site of a methyl isocyanate gas leak in 1984, which affected half a million people. The Indian Council of Medical Research set up a coordinating unit in the immediate aftermath, which was upgraded to the Bhopal Gas Disaster Research Centre in 1986 and then the Centre for Rehabilitation Studies in 1995. Relevant changes Scientists at the institute undertake environmental monitoring and health risk assessment studies among communities located near polluted areas, such as industrial areas. They are also assessing the training needs of practising physicians, with the aim of developing a curated curriculum to meet the deficiencies in environmental health education in the country. Lessons learnt Environmental legislation was introduced in the wake of the disaster and a research institute in environmental health was established. Researchers at the institute have recognized the importance of engaging communities in environmental health research, as well as knowledge dissemination to relevant stakeholders.


Introduction
Multiple environmental issues ranging from pollution to climate change threaten public health worldwide. According to the 2016 World Health Organization (WHO) report, an estimated 24% of global mortality and 28% of mortality in children younger than 5 years are attributable to environmental risk factors. 1 Air pollution is directly responsible for approximately 7 million annual deaths around the globe. 1 Inadequate access to drinking water and poor sanitation are the causes of an estimated 58% of all cases of diarrhoea in low-and middle-income countries, resulting in 0.8 million premature deaths annually. 1 WHO has predicted that the effects of climate change will lead to an additional 250 000 deaths every year from 2030 to 2050 as a result of higher numbers of cases of climate-sensitive diseases such as malnutrition, malaria, diarrhoea and heat stress. 2 The burden of mortality and morbidity attributable to environmental risk factors including climate change is especially significant in low-and middle-income countries, [1][2][3] where 82% of the total global population resides. 3 In India, many cities have observed high annual concentrations of particulate matter and corresponding high morbidity as a result of air pollution. 4 According to the 2019 report by the National Institution for Transforming India, many regions in India are currently experiencing water stress (affecting almost 820 million people) and 70% of surface water across the country is polluted, endangering the health and lives of almost 8 million Indian children. 5 Improvement in public health via improvement in the quality of the environment is one of the most pressing issues for low-and middle-income countries, including India. By means of its sustainable development goals, the United Nations is currently prioritizing global action to meet human developmental needs while minimizing environmental degradation, consequently protecting health. 6 Accordingly, high-income countries have been actively involved in environmental health research, while many low-and middle-income countries still need to establish environmental health research institutes. The National Institute for Research in Environmental Health, established by the Indian government in 2010, is unique in being one of the few institutes in South-East Asia solely dedicated to environmental health research, a topic that has only recently begun to be addressed within the wider scientific community. 7 Here we describe setting up the institute and its work.

Local setting
In 1984, a methyl isocyanate gas leak at the Union Carbide India Limited pesticide factory in Bhopal affected approximately half a million people, either by immediate or subsequent morbidity or mortality. 8 The leak is considered to be one of the most severe global industrial disasters. The increased environmental health awareness in India resulting from the Bhopal disaster led to changes not just in science (through the establishment of a national environmental health research institute) but also in legislation. Indian parliament enacted the 1986 Environment Protection Act to encompass the previous 1974 Water Act and 1981 Air Act, amended the 1948 Factories Act in 1987, and passed several new acts, such as the 1989 Hazardous Waste (Management and Handling) Rules, the 1996 Chemical Accidents (Emergency Planning, Preparedness and Response) Rules and the 2005 Disaster Management Act. 9 Impact assessments of the environmental risks posed by any large-scale project before its establishment, as well as periodical follow-up assessments, became mandatory with Problem Multiple environmental health issues resulting from pollution and climate change threaten public health in India. Approach The Government of India recognized the need for a permanent environmental health research institute; the Indian Council of Medical Research therefore established the National Institute for Research in Environmental Health in Bhopal in 2010. Scientists at the institute assessed the multiple long-term health effects of exposure to methyl isocyanate, and are now conducting research on a wide array of locally relevant environmental health issues. Local setting The Union Carbide India Limited pesticide factory in Bhopal was the site of a methyl isocyanate gas leak in 1984, which affected half a million people. The Indian Council of Medical Research set up a coordinating unit in the immediate aftermath, which was upgraded to the Bhopal Gas Disaster Research Centre in 1986 and then the Centre for Rehabilitation Studies in 1995. Relevant changes Scientists at the institute undertake environmental monitoring and health risk assessment studies among communities located near polluted areas, such as industrial areas. They are also assessing the training needs of practising physicians, with the aim of developing a curated curriculum to meet the deficiencies in environmental health education in the country. Lessons learnt Environmental legislation was introduced in the wake of the disaster and a research institute in environmental health was established. Researchers at the institute have recognized the importance of engaging communities in environmental health research, as well as knowledge dissemination to relevant stakeholders.  11 The institute was set up with a broad mandate of research in environmental health topics affecting the Indian population, including the long-term health effects of the Bhopal gas disaster. Initially the institute started functioning with recruitment of nominal staff and the administrative process was initiated to recruit more human resources and to develop the laboratory infrastructure. The State government of Madhya Pradesh provided the initial infrastructure at the old premises at Kamla Nehru Hospital and the land for the construction of a new, bigger campus. In the initial phase most of the projects were related to the health of the gas tragedy survivors, implemented by collaborative efforts of researchers from this institute and other organizations. After obtaining administrative approval, the recruitment procedure was started following the guidelines adopted by the Indian Council of Medical Research. The council provided relevant induction training to newly recruited scientists in matters related to relevant scientific and administrative work, whereas other technical and administrative staff were trained by senior staff working in the institute. As research activities increased with the advent of new scientists, relevant equipment was purchased and laboratories were established through intramural funds provided by the Indian Council of Medical Research as well as by using funds awarded to individual scientists as research grants.
In the meantime, the permanent campus of the institute was built, with a budget of 1240 million Indian rupees (equivalent to 17.89 million United States dollars) from the Indian government. As a role model to the nation in the adoption of sustainable development practices, the permanent campus of the institute was constructed following the tenets of the Indian Green Building Council to maximize energy and water conservation, while safeguarding the health of the workforce as well as the surrounding environment. 12 The campus minimizes its negative effects on the environment and ecosystem with efficient water and waste management strategies (e.g. rainwater harvesting, single-use plastic ban), energy efficiency (e.g. motion-sensitive lighting, maximum use of natural light, minimum outdoor light pollution) and green landscaping. 12 The Union Minister of Health and Family Welfare inaugurated and dedicated the new green campus of the institute to the nation at a ceremony on 13 March 2021. 13

Relevant changes
Researchers at the institute recruited and followed up a cohort of individuals affected by the Bhopal disaster to assess the multiple long-term health effects of exposure to methyl isocyanate. 14 They are now conducting research on a wide array of locally relevant environmental health issues including: (i) molecularlevel research to understand the effect of exposure to air pollutants at the epigenetic level; (ii) nanotechnologybased point-of-care diagnostics for pollution-induced diseases such as lung cancer; and (iii) epidemiological studies to understand the burden and distribution of environmental issues such as air pollution, crop residue burning, built environments, noise pollution and chemical water pollution at regional and national levels.
Since 2016, scientists of the institute have been undertaking environmental monitoring and health risk assessment studies among communities located near industrial areas. They are also as-sessing the training needs of practising physicians, with the aim of developing a curated curriculum to meet the deficiencies in environmental health education in the country. The need for national research capacity-building in the field of environmental health has been identified; researchers of the new institute therefore provide relevant short-term training programmes both in basic science and public health.
The idea of green social responsibility was promoted at the inauguration ceremony of the institute, based on Principle 10 of the 1992 Rio Declaration on Environment and Development. Such a policy requires public outreach and knowledge dissemination to generate motivation within communities to adopt pro-environmental behaviour. By encouraging communities to make simple changes to their daily activities (e.g. reducing water waste, separating recyclable and compostable waste from landfill, and switching off electrical appliances when not in use), they can reduce their negative impact on the environment. The Indian government is eager to adopt a similar stance to policy-makers in high-income countries that are already developing interventions to encourage behaviour change. 15 Therefore, scientists of the institute are actively engaging the community in research to educate and empower them to adopt pro-environmental behaviour, while also attempting to educate other Indian public health researchers in the context of community-based participatory research by organizing training courses.

Lessons learnt
The institute now has an essential role to play in conducting biomedical research on environmental health issues, assessing exposure to environmental pollutants, advocating for relevant mitigation measures and developing the capacity of India in promoting environmental health. The gas tragedy highlighted the disastrous effects of exposure to chemical pollutants on human health. Therefore, the scientists at the institute conduct research among communities residing in potential high pollution zones such as industrial areas (Box 1).
In the initial phase, as the institute lacked sufficient human resources, space and equipment, most of the conducted research was of an epidemiological or Lessons from the field National Institute for Research in Environmental Health, India Tanwi Trushna & Rajnarayan R Tiwari survey-based nature and was mostly restricted to the health effects of the gas tragedy. Gradually, with procurement of environmental monitoring equipment, recruitment of specialist scientists and finally the availability of the new, bigger campus with ample space to develop laboratory infrastructure, the institute has started diversifying its research focus into multiple environmental health issues such as air and water pollution, waste management and climate change.
In the future, the institute aims to initiate, through collaboration with other institutes under the Indian Council of Medical Research and reputed medical colleges in the country, a pan-India five-yearly cycle of cross-sectional surveys at province-level to collect information on key health, environment and nutritionrelated parameters in the Indian population. Collection of such data will help to fill the gaps in current literature, in addition to assisting with policy-making.
Similarly, the scientists of the institute are working to establish urban and rural cohorts to assess the long-term effects of exposure to environmental pollutants specific to the Indian context. ■

Creación del National Institute for Research in Environmental Health, India
Situación Los diversos problemas de salud ambiental derivados de la contaminación y el cambio climático amenazan la salud pública en la India. Enfoque El Gobierno de la India reconoció la necesidad de contar con un instituto permanente de investigación en salud ambiental; en consecuencia, el Consejo de Investigación Médica de la India creó el National Institute for Research in Environmental Health (Instituto Nacional de Investigación en Salud Ambiental) en Bhopal en 2010. Los científicos del instituto valoraron los múltiples efectos sanitarios a largo plazo de la exposición al isocianato de metilo, y ahora están investigando una gran variedad de problemas de salud ambiental de importancia local. Marco regional La fábrica de plaguicidas Union Carbide India Limited de Bhopal fue el lugar donde se produjo una fuga de gas de isocianato de metilo en 1984, que afectó a medio millón de personas. El Consejo de Investigación Médica de la India creó una unidad de coordinación tras la fuga, que se convirtió en el Bhopal Gas Disaster Research Centre (Centro de Investigación de la Catástrofe por Gas de Bhopal) en 1986 y en el Centre for Rehabilitation Studies (Centro de Estudios para la Rehabilitación) en 1995. Cambios importantes Los científicos del instituto realizan estudios de monitoreo ambiental y valoración de riesgos para la salud entre las comunidades ubicadas cerca de las áreas contaminadas, como las zonas industriales. También están valorando las necesidades de formación de los médicos en ejercicio, con el objetivo de elaborar un plan de estudios seleccionado para cubrir las deficiencias de la formación en salud ambiental en el país. Lecciones aprendidas La legislación ambiental se estableció como consecuencia de la catástrofe y se creó un instituto de investigación en salud ambiental. Los investigadores del instituto han reconocido la importancia de involucrar a las comunidades en la investigación de la salud ambiental, así como la difusión de conocimientos a las partes interesadas.